Evaluating the advancements and efficacies in pharmacological Mpox treatments: a comprehensive review.

Monkeypox, now known as Mpox, has reemerged as a serious public health threat due to an increasing number of outbreaks outside its primary endemic regions. Although virologically similar to smallpox, smallpox therapy is not specifically approved for Mpox. The goal of this review is to assess the pharmacological progress and therapeutic efficacy of available and new therapies for Mpox. Structured literature review methodology was used based on peer-reviewed articles, clinical trials data and global health agency reports published from 2008 to 2025. Data was collected from ClinicalTrials.gov, Scopus and WHO databases with keywords on antiviral pharmacodynamics, resistance mechanism and clinical outcome. Prominent reviewed stewards include tecovirimat, brincidofovir, and cidofovir: drugs first developed for smallpox but repositioned for Mpox under expanded access programs. Tecovirimat seems most promising, however endangered by emerging resistance mutations. Innovative strategies, including mRNA vaccines, use of nanoparticles for drug delivery and host-directed treatments, are discussed that may improve treatment efficacy and preparedness for outbreaks. The results underscore that combination regimens will be required to counter resistance, there is a need for increased access in low- and middle-income countries, and global health cooperation should be bolstered. The review endorses increased clinical trial capacities, amended regulatory approaches development of new classes of therapeutics as part of global Mpox response efforts. By combining pharmacological breakthroughs with public health readiness, global health communities can be better equipped to respond to Mpox and other possible orthopox outbreaks of the future.